Provider Demographics
NPI:1255418463
Name:FUNK, JASON BYRON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:BYRON
Last Name:FUNK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-300-1000
Mailing Address - Fax:530-674-0545
Practice Address - Street 1:899 GRAY AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3635
Practice Address - Country:US
Practice Address - Phone:530-300-1000
Practice Address - Fax:530-674-0545
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0303690Medicare ID - Type UnspecifiedMEDICARE #
CAV10594Medicare UPIN
CAZZZ02143ZMedicare ID - Type UnspecifiedGROUP MEDICARE #